Iatrogenic open globe eye injury following sinus surgery

Purpose

To report a case of iatrogenic open globe eye injury occurring during endoscopic sinus surgery.

Design

Case report and literature review.

Methods

A 10-year-old boy presented with periorbital swelling and subconjunctival hemorrhage of the left eye following bilateral nasal adenoidectomy. Funduscopic examination showed evidence of a full-thickness open globe injury at the equator in the inferior nasal midperiphery.

Results

The injury most likely was secondary to inadvertent perforation of the lamina papiracea with entrance into the orbit and subsequent penetration of the globe.

Conclusion

Sinus surgery has been reported previously in association with severe orbital complications. We are unaware of previous reports of open globe injury following sinus surgery.     

Optical coherence tomography under general anesthesia in a child with nystagmus

Purpose

To describe a method that permits optical coherence tomography scanning to be performed under general anesthesia.

Design

Observational case report.

Methods

A 7-year-old child underwent optical coherence tomography scanning under general anesthesia. He was positioned prone, with the neck extended to enable vertical facial alignment on the scanner. An anti-Trendelenburg trend on the operating table minimized the degree of neck extension required. Intravenous fluids, modest ventilator airway pressures, and compression stockings were used to minimize perioperative hemodynamic disturbance and the potential for orthostatic hypotension associated with the anti-Trendelenburg trend.

Results

High-quality, diagnostically important optical coherence tomography scans were obtained.

Conclusion

With appropriate patient positioning and anesthetic management, optical coherence tomography scanning can be performed on uncooperative adults and children under general anesthesia.     

Retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification

Purpose

To report a method of retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification.

Design

Interventional case report.

Methods

A 65-year-old man presented with a totally luxated crystalline lens in the vitreous cavity of the left eye. After total vitrectomy was performed, a viscoadaptive viscoelastic agent was applied over the retina and optic disk. Then the luxated lens was removed by intravitreal phacoemulsification. The lens dropped several times during the surgery but the thick viscoadaptive viscoelastic agent protected the posterior retina.

Results

In two cases treated this way, no complications occurred at six months after surgery.

Conclusion

This method may be useful for protecting the retina from damage by a luxated crystalline lens and is less costly than perfluorocarbon liquid.     

Increased ocular pulse amplitude revealing aortic regurgitation

Purpose

To report a case in which observation of increased ocular pulse amplitude (OPA) estimates in both eyes lead to a diagnosis of, and was presumably due to, aortic regurgitation.

Design

Case report.

Methods

An incidental finding of high OPA estimates in both eyes lead to a finding of widened arterial pulse pressure and aortic regurgitation. OPA estimates were taken after aortic valve surgery when arterial pulse pressure was normal.

Results

OPA estimates were 9 mm Hg in both eyes when arterial pulse pressure was high and 3 mm Hg in each eye when normal.

Conclusion

Widened arterial pulse pressure may lead to increased OPA.     

Botulinum Toxin for Lower Lid Entropion Correction

This prospective clinical study was designed to evaluate the efficacy of botulinum toxin for temporary treatment of senile and congenital lower lid entropion. Seventeen patients with senile entropion and three children with congenital entropion were treated with botulinum toxin injection into the preseptal orbicularis muscle of lower lid. This resulted in transient relieve of the condition, which lasted for a period of 8–26 weeks. This technique is easy and effective for senile entropion as well as certain cases of congenital entropion.     

Clinical agreement among glaucoma experts in the detection of glaucomatous changes of the optic disk using simultaneous stereoscopic photographs

Purpose

To evaluate the clinical agreement in the detection of optic disk changes in patients with glaucoma using simultaneous stereophotographs.

Design

Masked-observer variability study.

Methods

Ten glaucoma specialists examined pairs of simultaneous stereophotographs of glaucomatous and control optic disks to determine whether there were changes compatible with progression of glaucomatous damage.

Results

Intraobserver agreement had a kappa value ranging from 0.55 to 0.78. Interobserver agreement among the glaucoma specialists had a kappa value ranging from 0.34 to 0.68.

Conclusion

Clinical examination of stereophotographs to detect optic disk changes in glaucoma patients has limitations associated with suboptimal reproducibility.     

Botulinum toxin for lower lid entropion correction

This prospective clinical study was designed to evaluate the efficacy of botulinum toxin for temporary treatment of senile and congenital lower lid entropion. Seventeen patients with senile entropion and three children with congenital entropion were treated with botulinum toxin injection into the preseptal orbicularis muscle of lower lid. This resulted in transient relieve of the condition, which lasted for a period of 8-26 weeks. This technique is easy and effective for senile entropion as well as certain cases of congenital entropion.     

Enlargement of parapapillary atrophy in follow-up of chronic open-angle glaucoma

Purpose

To assess the frequency of an enlargement of parapapillary atrophy in follow-up of eyes with open-angle glaucoma.

Methods

Prospective observational longitudinal study.

Setting

Institutional.

Patients

The study included 978 eyes (511 Caucasian subjects) with open-angle glaucoma (n = 548; including 194 eyes with normal-pressure glaucoma), ocular hypertension (n = 289), or without optic nerve disease (n = 141). Highly myopic eyes with a myopic refractive error exceeding −8 diopters were excluded. Mean follow-up was 4.5 ± 2.4 years (median, 3.8 years; range: 1.5 to 9.8 years).

Observation procedures

Optic disk photographs taken annually.

Main outcome measures

Two examiners compared optic disk slides for enlargement of parapapillary atrophy (zone beta) and for signs of progressive disk damage.

Results

An enlargement of parapapillary beta zone was detected in 16 eyes (1.6%) after 3.9 ± 2.6 (0.6 to 9.1) years of follow-up. It was observed in 15 eyes (2.7%) with open-angle glaucoma, 1 eye (0.3%) with ocular hypertension, and in none of the normal eyes. After excluding eyes with a myopic refractive error exceeding −3 diopters, enlargement of beta zone was significantly more common in eyes with progressive glaucoma (5/81or 6.2%) than in eyes with nonprogressive glaucoma (3/354 or 0.8%; P < .001).

Conclusions

Parapapillary atrophy (zone beta) enlarges during follow-up of relatively few eyes with chronic open-angle glaucoma. In the refractive range above −3 diopters, enlargement of beta zone occurs significantly more frequently (P < .001) in progressive glaucoma than in nonprogressive glaucoma. In view of its low frequency, enlargement of beta zone may not be a very useful marker for glaucoma progression.     

Detection of localized retinal dysfunction in a choroideremia carrier

Purpose

To investigate severe unilateral vision loss in a choroideremia carrier.

Design

Case report.

Methods

Ocular examination, genetic testing, Humphrey visual fields, full-field and multifocal (mf) electroretinogram (ERG) tests were used to study a family with choroideremia.

Results

In a carrier with unilateral central vision loss, mfERG showed severely reduced amplitudes which correlated with a band of retinal pigment epithelial and choroidal atrophy in the macula, a dense central scotoma on Humphrey visual fields testing, and decreased ERG amplitudes.

Conclusions

Multifocal ERG may be a sensitive tool to measure functional abnormalities in choroideremia carriers. Mosaic inactivation of the normal gene may cause expression of the mutation with severe vision loss in choroideremia carriers.     

Epiretinal membrane surgery assisted by trypan blue

Objective

To evaluate patient outcome following epiretinal membrane surgery using trypan blue to facilitate visualization and delamination.

Design

A retrospective noncomparative review of 23 patients.

Methods

Patients underwent a three-port pars plana vitrectomy with delamination using trypan blue 0.06%.

Results

The median preoperative visual acuity was 20/100. The median postoperative visual acuity was 20/60. Seventeen patients (74%) improved their visual acuity by at least 2 chart lines. No adverse reaction related to trypan blue was observed up to 1 year postoperatively.

Conclusions

Trypan blue staining of the epiretinal membrane facilitated visualization and delamination without any signs of toxicity.     

Entropion in children with isolated peripheral facial nerve paresis

Purpose

Adults with facial nerve paresis (FNP) generally develop ectropion, but a recent report of children with syndromatic FNPs implies that entropion may be more common in this setting than ectropion. This study evaluates eyelid position and other periorbital changes in children with isolated, non-syndromatic FNP.

Methods

Charts were reviewed of 10 sequential children who presented to a major national eye referral centre with isolated FNP of variable aetiology. Severity of FNP was assessed according to the House-Brackmann scale.

Results

All 10 patients (4 males and 6 females; mean age at presentation, 4 years) had unilateral, isolated FNP. Mild lower-eyelid entropion was present in four patients, and severe lower-eyelid entropion required surgical correction in three patients. All patients had lower eyelid retraction (mean 2.3 mm) and lagophthalmos (mean 2.9 mm). None had enophthalmos, lower eyelid ectropion, or brow ptosis.

Conclusion

Unlike adults, children with isolated FNP seem prone to develop entropion rather than ectropion. Entropion reported previously in five syndromic children with FNP seems more likely related to patients'' age than to their congenital syndromes.     

A prospective, pilot study of treatment of amblyopia in children 10 to <18 years old

Purpose

To determine whether amblyopia can be successfully treated in older children and adolescents.

Design

Prospective, single group treatment trial.

Methods

Sixty-six amblyopic patients aged 10 to <18 years with amblyopic eye acuity of 20/40 to 20/160 were treated with daily patching (≥2 hours a day) combined with at least 1 hour of near activities. Visual acuity was measured before and after 2 months of prescribed treatment.

Results

Visual acuity improved 2 or more lines from baseline in 18 (27%) of the 66 patients (95% confidence interval, 17%-40%), and the improvement appeared similar in 10- to <14-year-olds and 14- to <18-year-olds.

Conclusions

Amblyopia treatment can improve visual acuity in older children and adolescents. A randomized controlled trial is needed to determine if there is an upper age limit for which amblyopia treatment is successful.     

Biomechanical properties of the cornea in high myopia

Purpose

To determine corneal biomechanical properties in patients with high myopia.

Design

Observational study.

Methods

High myopia patients (n = 45, age: 37.0 ± 12.6 years) with refractive errors of spherical equivalent (SE) greater than −9.00 D were recruited in this study along with healthy subjects (n = 90, age: 33.7 ± 12.4 years) with refractive errors of SE ranging from 0 D to −3.00 D. Only the right eye was studied. Central corneal thickness (CCT) was measured by optical coherence tomography (OCT). Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the Ocular Response Analyzer (ORA). The ORA also determined the values of intraocular pressure (IOP_g) and corneal compensated IOP (IOP_cc).

Results

No significant differences of CCT and CRF were present between the two groups (P = .15 and 0.35 for CCT and CRF, respectively); however, CH in the high myope group was lower than that in the controls (P < .01). IOP_g and IOP_cc were both significantly higher in the high myopes compared to the controls. In both groups, there were significant correlations between CH and CCT and between CRF and CCT. CH was not significantly correlated with age in either the control group or the high myope group (P > .05). There was a significant correlation between CH and SE when the two groups were combined for analysis.

Conclusion

CH, but not CRF, was significantly lower in high myopia patients compared to that in normal subjects. The results indicate that some compromised aspects of the biomechanical properties of cornea may exist in people with high myopia.     

Combined pentagonal resection and inferior retractor plication in involutional entropion

Background

To describe the effectiveness of combined pentagonal resection and inferior retractor plication (PR?+?IRP) based on the Hill’s procedure for the treatment of primary involutional lower eyelid entropion in the Chinese population.

Methods

This is a retrospective review of 52 eyelids of 46 patients who underwent PR?+?IRP for treatment of involutional entropion between May 2009 and May 2017. Patient demographics, presence of pre-operative laxity, post-operative outcome and presence of complications were all recorded from electronic patient records.

Results

A total of 52 eyelids of 46 patients received PR?+?IRP. None had recurrence of entropion, 1 (2.1%) had residual entropion, 2 eyelids (4.4%) had lower eyelid notching, 1 eyelid (2.2%) had infection and 1 eyelid (2.2%) had overcorrection. The overall success rate was 90.4%.

Conclusion

Combined PR?+?IRP is an effective surgical procedure for primary involutional entropion with low recurrence rate. However, it may carry risk of eyelid notching post-operatively.

     

Inhibitory effects of bevacizumab on angiogenesis and corneal neovascularization

Background

To evaluate the inhibitory effects of bevacizumab (Avastin®) on angiogenesis using cultured human umbilical vein endothelial cells (HUVECs) in vitro and on corneal neovascularization by subconjunctival injection of bevacizumab in vivo.

Methods

After the HUVECs were exposed to different concentrations of bevacizumab stimulated with VEGF (10 ng/ml) for 2, 6, and 24 hours, cellular-activity-like proliferation, migration and tube formation were assessed. Subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) was performed after corneal chemical burn injury. Then the cornea was evaluated by biomicroscopy, fluorescein angiography, and light microscopy.

Results

The inhibitory effects of bevacizumab on VEGF-induced HUVECs proliferation showed a dose-dependent response for 2 and 6 hours, but all groups were effectively inhibited regardless of the concentration of bevacizumab for 24 hours. The inhibitory effects of bevacizumab on the migration of VEGF-induced HUVECs showed a time- and dose-dependent response. The inhibitory effects of bevacizumab on VEGF-induced HUVECs tube formation showed a dose-dependent response only for 24 hours. On days 3 and 8 after the subconjunctival injection, bevacizumab-treated eyes showed less neovascular growth than BSS-treated eyes in biomicroscopic, fluorescein angiographic, and light microscopic findings in vivo.

Conclusions

Bevacizumab effectively inhibits angiogenesis and corneal neovascularization, and could be used as a inhibitor of corneal neovascularization in the future.

     

A Case of Herpetic Keratitis after Subconjunctival Triamcinolone Acetonide Injection

Purpose

We report a case of herpetic epithelial keratitis that developed after subconjunctival triamcinolone acetonide injection (STI).

Methods

A 65-year-old female with anterior uveitis and hypotony in her right eye was given a STI (2 mg/0.5 ml). After the injection, she developed redness and an ocular discharge. A clinical examination was performed and real-time polymerase chain reaction (PCR) was used to amplify the viral DNA in a corneal scraping.

Results

Slit-lamp biomicroscopy revealed a severe purulent discharge, conjunctival injection, and a geographic corneal ulcer in the right eye. Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR. Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started. The inflammation subsided with this medication.

Conclusion

We encountered a case of herpetic epithelial keratitis after a STI.Key words: Herpetic keratitis, Subconjunctival triamcinolone acetonide injection, Anterior uveitis, Polymerase chain reaction, Hypotony     

Sensitivity and specificity of the 76-suprathreshold visual field test to detect eyes with visual field defect by Humphrey threshold testing in a population-based setting: the Thessaloniki eye study

Purpose

To evaluate the screening performance of the 76-Suprathreshold (76-STHR) visual field test to detect eyes with visual field defect (VFD) as measured by Humphrey threshold testing in a population-based setting.

Design

Cross-sectional study.

Methods

All 88 subjects who agreed to participate in the pilot phase of the Thessaloniki Eye Study were included. Participants underwent a 76-STHR visual field test followed by a 30-full threshold (30-2 FTHR) test (Humphrey field analyzer). One eye/subject was randomly selected and included in the analysis. Sensitivity and specificity rates of the 76-STHR to detect eyes with VFD by the 30 to 2 FTHR test were calculated.

Results

When eyes with borderline results in the 30 to 2 FTHR test were classified as having a VFD, sensitivity rates of the 76-STHR to detect eyes with VFD by the 30 to 2 FTHR were 85.2%, 77.8%, and 74.1%, whereas specificity rates were 70%, 78%, and 86%, depending on the cutoff used for the 76-STHR.

Conclusions

The 76-STHR test showed high sensitivity and low false-negative results at the “at least one point missed” cutoff level criterion to detect eyes with visual field defect by Humphrey threshold testing in a population-based setting. This criterion should be used when screening in a population-based study setting. By contrast, the 76-STHR would not be the appropriate screening test in a primary care setting with limited resources.     

Prognostic factors influencing visual outcome of photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia

Purpose

To examine the influence of age, lesion size, degree of myopia, and baseline visual acuity on the visual outcome of patients with pathologic myopia and choroidal neovascularization (CNV) who received photodynamic therapy (PDT) with verteporfin.

Design

Retrospective, noncomparative consecutive case series.

Methods

Forty-three eyes of 41 patients were treated in a two-year time span; 36 eyes of 36 patients who had received PDT for CNV due to pathologic myopia were examined for the above-mentioned factors 24 months after first treatment.All patients had been treated according to the Verteporfin in Photodynamic Therapy (VIP) study criteria. Patients were examined in two- to three-month intervals with Snellen visual acuity, biomicroscopy, and fluorescein angiography.

Results

Baseline visual acuity and age were both prognostic factors for visual outcome (P = .0097, P = .0055). Lesion size (greatest linear dimension) at baseline, refractive error, or the number of treatments had no influence on the outcome.

Conclusion

Age and baseline visual acuity have an effect on visual outcome in patients receiving PDT due to CNV secondary to pathologic myopia. Younger patients and patients with higher baseline visual acuity had a better treatment outcome.     

The Effect of Bevacizumab versus Ranibizumab in the Treatment of Corneal Neovascularization: A Preliminary Study

Purpose

To compare the short term effects of bevacizumab and ranibizumab injections on the regression of corneal neovascularization (NV).

Methods

Sixteen eyes of 16 patients with corneal NV were randomly assigned for an injection with 2.5 mg of bevacizumab (group 1, n = 8) or 1 mg of ranibizumab (group 2, n = 8) through subconjunctival and intrastromal routes. The patients were prospectively followed-up for one month after the injections. Corneal NV areas, as shown on corneal slit-lamp photographs stored in JPEG format, were calculated using Image J software before the injection, one week after the injection, and one month after the injection. The corneal NV areas were compared before and after the injections.

Results

Seven women and nine men, with an average age of 51 years, presented with corneal NV secondary to herpetic keratitis (7 cases), graft rejection (6), chemical burn (1), pemphigoid (1), and recurrent ulcer (1). In group I, the preoperative corneal NV area (8.75 ± 4.33%) was significantly decreased to 5.62 ± 3.86% one week after the injection and to 6.35 ± 3.02% one month after the injection (p = 0.012, 0.012, respectively). The corneal NV area in group 2 also exhibited a significant change, from 7.37 ± 4.33% to 6.72 ± 4.16% one week after the injection (p = 0.012). However, no significant change was observed one month after the injection. The mean decrease in corneal NV area one month after injection in group 1 (28.4 ± 9.01%) was significantly higher than in group 2 (4.51 ± 11.64%, p = 0.001).

Conclusions

Bevacizumab injection resulted in a more effective and stable regression of corneal NV compared to the ranibizumab injection. The potency and dose of these two drugs for the regression of corneal NV require further investigation.